Written by Millie Cossé
A reduction in both 24-hour and in-hospital mortality was seen among children who received a transfusion after traumatic injury in the prehospital setting compared to those who were transfused in the emergency department.
They’re not bleeding salt water
This retrospective cohort study examined 559 patients age 0 to 17 years-old over a period of 10 years who received a blood transfusion for traumatic injury in either the prehospital setting or the emergency department. Data was collected from the Pennsylvania Trauma Systems Foundation Registry (which includes more than 50 trauma centers). A propensity score was used to match children who received transfusions in both settings. The primary outcome was 24-hour mortality, and secondary outcomes included in-hospital mortality and complications of traumatic injury (including VTE, sepsis, AKI, and ARDS, etc.). A mixed-effects logistic regression model was used to study the association between prehospital transfusion (PHT) and emergency department transfusion (EDT). Authors found that 24-hour (16% vs 27%) and in-hospital mortality (21% vs 32%) were lower in the PHT cohort compared with the EDT cohort, respectively. These results suggest that the number needed to treat to reduce 24-hour mortality was 6 (95%CI 3-10) and the number needed to treat to reduce in-hospital mortality was 5 (95%CI 4-10).
How will this change my practice?
I feel like I’m constantly hearing about nation-wide blood shortages, and it’s difficult to imagine such an in-demand resource being distributed widely enough to be accessible to patients across the country. That said, a NNT of 6 to prevent mortality in kids is a compelling argument, and I think this study helps support ongoing efforts to move transfusion to the immediate post-injury period.
Association of Prehospital Transfusion With Mortality in Pediatric Trauma. JAMA Pediatr. 2023 Jul 1;177(7):693-699. doi: 10.1001/jamapediatrics.2023.1291.